Information for injured persons and Social Security disability claimants in Texas and throughout the United States. By Robert A. Kraft

About My Blog

The purpose of this blog is to provide information to people who have been injured due to negligence, and to those who have filed for Social Security disability benefits, or who are considering filing for Social Security disability benefits.

Our Dallas, Texas personal injury and Social Security disability lawyers want to help. To find answers to your questions, please use the Google search box or the Categories list below. If you still don't find what you need, just send an e-mail to me at info@kraftlaw.com and I'll get right back to you.

March 29, 2011

"Prices are almost always inflated before being routinely discounted. Amid such financial flimflammery, it's virtually impossible for a patient to be a well-informed consumer of healthcare."

That was the subtitle of an article in the Los Angeles Times recently. The gist of the article is that medical bills, especially hospital bills, are almost impossible for patients to decipher because there are so many different prices for the same services, depending on the insurance status of the patient. Please click the link to read the full article — it's an eye-opener. Here are the opening paragraphs:

Susan Kovinsky underwent outpatient surgery recently at Cedars-Sinai Medical Center. The procedure, a hysterectomy, began at 10:40 a.m. By 3 p.m., she was on her way home.

The hospital bill: $65,514.97.

"When I saw that number, I was sure it couldn't be right," Kovinsky, 44, of North Hollywood told me. "How could just a few hours in the hospital cost that much?"

Yet this is a story of the healthcare system working as it's intended to. Cedars-Sinai did its job. Kovinsky's insurer, Blue Shield of California, did its job. Kovinsky has no complaints about either.

But if we ever intend to get our healthcare spending under control, clearly there's much to be done to reform a system in which a relatively common procedure and less than a day in the hospital costs more than a fully loaded 535i BMW sedan.

Kovinsky's case is illustrative of the problem. Medical bills are almost always inflated before being routinely discounted. This is done by hospitals and doctors to boost their reimbursement from insurers.

The upshot, though, is that amid such financial flimflammery, it's virtually impossible for a patient to be a well-informed consumer of healthcare.

September 09, 2009

CNNMoney has published a disturbing article
explaining why more and more family physicians are refusing to give
vaccine shots. The answer is that the health insurance companies won't
reimburse the doctors for the full cost of administering the vaccines.
If a doctor is going to lose money on every vaccination, that doctor is
eventually going to quit doing vaccinations. And while there are
alternatives, such as free clinics and public hospitals, the sad truth
is that many parents will just skip the vaccination rather than go to
the extra trouble. This is bad news for the children. Here are excerpts
from the article:

Parents
who bring their kids to Dr. G. Andrew McIntosh for the chicken pox
vaccine are out of luck. The family physician, who has a solo practice
in Uniontown, Ohio, doesn't offer that shot because he can't afford it.
Most insurers won't sufficiently cover the cost.

"It
doesn't do me any good. I am losing money on [them]," he said. The
chicken pox vaccine runs about $115, but insurers only cover between
$68 to $83 of that. McIntosh has also cut back on a handful of other
critical childhood vaccines for the same reason -- including the
measles, mumps and rubella, known as the MMR vaccine.

It costs
him about $58 to buy an MMR shot, he said, while insurers pay about
about $40. So McIntosh keeps a lot less of the MMR on hand. If a
patient needs the shot and he doesn't have it, he sends them to a
nearby public health clinic.

"I'm not
happy to do that," he said. "The clinic is far, the service isn't great
and my patients aren't happy to go there." "I've lost a fair number of
kids [at the practice] because I've had to send them elsewhere for
their shots," he said.

It's not
clear exactly how widespread vaccine cutbacks are, but in a recent
industry survey, 5% of pediatricians and 11% of physicians indicated
that they're seriously considering no longer offering immunizations.
Currently there are about 350,000 pediatricians and family physicians
in the U.S.

"These
are fantastically alarming numbers," said Dr. Richard Lander, a
Livingston N.J.-based pediatrician who chairs a committee on
administration and practices at the American Academy of Pediatricians.
"It's an example of how health care is being driven by managed care in
the United States," Lander said.

Doctors
have to absorb any costs that insurance doesn't cover because in most
states insurance contracts prohibit providers from charging patients
the difference.

Public
health experts are particularly worried about doctors dropping
vaccinations. Dr. Lance Rodewald, head of the Immunization Services
Division at the Centers for Disease Control and Prevention, points to
the consequences this trend has had on public health in the past.

"Between
1989 to 1991, a number of doctors stopped providing vaccinations to
children because of financing issues," he said. Instead, doctors
referred patients to public health clinics for shots like the MMR. But
many parents failed to follow up on those shots, Rodewald said, and
their toddlers were never immunized. The result: The situation led to
55,000 cases of measles, 11,000 hospitalizations and 123 toddler
deaths. The CDC found that more than half of the children who had
contracted the measles had not been vaccinated, even though many of
them had seen a health care provider.

The
lawsuits heap more criticism on Ingenix Inc. data that already has cost
UnitedHealth Group Inc. $350 million to settle a separate lawsuit
involving the AMA. Ingenix is a UnitedHealth subsidiary.

The
latest complaints accuse Aetna of deleting valid high charges from
figures contributed to an Ingenix database. They also accuse Cigna of
hiding "serious, systemic flaws" in the data.

Insurers use the data to determine "usual and customary rates" for care received outside their networks.

But
Aetna and Ingenix "cooked the books" and corrupted the database,
according to a complaint filed Monday in U.S. District Court in New
Jersey. That led to skewed data, which lowered the reimbursement
doctors received.

"It's time for Aetna and Cigna to stop this
unethical business practice that shocks our patients with unexpectedly
high bills for health care they thought they'd already paid for," said
Dr. Josie Williams, president of the Texas Medical Association and
assistant professor at Texas A&M University System Health Science
Center College of Medicine. "It's time for them to stop cheating
physicians and patients just to pad their own profits."

The insurer said prices charged by doctors are part of the problem.

It
noted, for instance, that doctors in the expensive New York City market
charge on average $214 for a 15-minute, out-of-network office visit.
Health plans reimburse as much as $160 using the Ingenix database.
Medicare pays doctors $77 for the same visit.

Aetna
has already agreed to pay $20 million to help set up a new database
that will replace the one run by Ingenix. UnitedHealth also pledged
last month to give $50 million toward the database's creation.

FDA ALERT [10/2007]: FDA has reviewed 30 postmarketing reports of acute pancreatitis in patients taking Byetta, a drug used to treat adults with type 2 diabetes. An association between Byetta and acute pancreatitis is suspected in some of these cases.

Healthcare professionals should instruct patients taking Byetta to seek prompt medical care if they experience unexplained persistent severe abdominal pain which may or may not be accompanied by vomiting. If pancreatitis is suspected, Byetta should be discontinued. If pancreatitis is confirmed, Byetta should not be restarted unless an alternative etiology is identified.

FDA has asked and the maker of Byetta, Amylin Pharmaceuticals, Inc. has agreed to include information about acute pancreatitis in the PRECAUTIONS section of the product label.

The stronger warning is based on the FDA's review of Ketek's postmarketing adverse event reports. Those records show 12 cases of acute liver failure -- four of which were fatal; a fifth required a liver transplant. There were also an additional 23 cases of acute liver injury.

Ketek's new label will advise doctors and patients to watch carefully for signs and symptoms of liver injury while taking Ketek and to discontinue the drug promptly if any signs or symptoms of liver injury are to develop.

When the FDA approved Ketek in April 2004, the drug's labeling included precautions about liver injury and possible worsening of myasthenia gravis, as with other drugs in its class.